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Index

Note: Page numbers followed by f indicate figures and t indicate tables.

AAF. See Anal advancement flap (AAF) AAST. See American Association for the Surgery

of Trauma (AAST)

Abscess

anorectal (see Anorectal abscess) perianal, in Crohn’s disease, 142–147

diagnosis of, 145 imaging of, 145–146

treatment for, 146–147 Acellular dermal matrix (ADM), 94 Acellular extracellular matrix (AEM), 94 Adalimumab, for perianal abscess and fistula

in Crohn’s disease, 146

Adipose-derived stem cells (ASC)

for anorectal abscess, 94

for anorectal fistula, 94 ADM. See Acellular dermal matrix (ADM) Advanced Trauma Life Support (ATLS),

208–210

Advancement flap

for anorectal abscess, 91–92, 92f

for anorectal fistula, 91–92, 92f AEM. See Acellular extracellular matrix (AEM) AFP. See Anal fistula plug (AFP) AGA. See American Gastroenterological

Association (AGA) Albendazole, for pinworm pruritus, 121 Altemeier operation, 255 Amebiasis, 132–133 American Association for the Surgery of

Trauma (AAST)

rectal injury grading system of hematoma,

208t American Gastroenterological Association

(AGA)

classification of perianal fistula, 144, 144t

Amitriptyline, for fecal incontinence, 171

Amussat, 29 Anal adenocarcinoma, 193 Anal advancement flap (AAF), for anal fissure,

75–76 Anal basal cell carcinoma, 196 Anal Buschke-Loewenstein tumor, 192 Anal carcinogenesis, 190–191 Anal-closure mechanism

anal-closure mechanism, functional

assessment of, 24–25, 24f

functional assessment of, 24–25, 24f in humans, anatomy and function

assessment of, 21–23, 23f Anal fissure

additional investigations for, 67, 68–71f definition of, 65, 66f diagnosis of, 66

–67

etiology

of,

65–66 pathophysiology of, 65–66 practical therapeutical guideline and

work-up, 76 and pruritus ani, 119–120, 120t specific conditions, 77

human immunodeficiency virus, 77 inflammatory bowel disease, 77

lues, 77 after surgery for anorectal diseases, 253 symptoms of, 66–67 therapy for, 67–76

conservative management, 72–75

surgical management, 75–76

Anal fistula plug (AFP)

for anorectal abscess, 93 for anorectal fistula, 93

Analgesics, for hemorrhoids, 119 Anal lymphoma, 195 Anal mass sensation, 194 Anal melanoma, 194–195

265

Anal MEPs, 42 Anal mesenchymal tumors, 195–196 Anal neuroendocrine tumors, 195 Anal plugs, for fecal incontinence, 172 Anal radiofrequency, for fecal incontinence,

173 Anal sexual intercourse, 191 Anal squamous cell carcinoma (SCC), 189 Anal squamous intraepithelial lesions, 189–191 Anal stricture, following a Milligan-Morgan

operation, 252f Anal tattooing, for pruritus ani, 118 Anal tumors, 189

anal adenocarcinoma, 193 anal basal cell carcinoma, 196 anal Buschke-Loewenstein tumor, 192 anal lymphoma, 195 anal melanoma, 194–195 anal mesenchymal tumors, 195–196 anal neuroendocrine tumors, 195 anal SCC, 191–192 anal squamous intraepithelial lesions,

189–191

extramammary Paget disease, 193–194 secondary tumors (metastases), anal canal,

196 Anocutaneous reflex assessment, 32 Anodermal advancement flap, 91–92, 92f Anoplasty, for anorectal malformations,

181–183, 184f Anorectal abscess

adipose-derived stem cells, 94 classification of, 82–83, 82f clinical presentation of, 83–84 in Crohn’s disease patients, treatment for,

95–97

laser ablation for, 95 nonsphincter-preserving operation, 90–91

fistulectomy, 90 fistulotomy, 90

seton, 90–91 over-the-scope-clip, 94–95 preoperative imaging of, 85–88, 86–87f sphincter-preserving operation, 91–95, 96f

advancement flap, 91–92, 92f

anal fistula plug, 93 fibrin glue injection, 92 ligation of intersphincteric fistula tract, 93 video-assisted ablation of the fistula tract,

treatment for, 88–89

Anorectal anatomy and function

anal-closure mechanism in humans,

anatomy and function assessment of, 21–23, 23f

deep pelvic floor muscles (levator ani)

anatomy and function, relationship

between, 14–17, 15–19f, 19–

external

anal

sphincter, 11–13, 12–13f

length-tension function of, 20, 21f

internal anal sphincter, 10–11, 10f

neural control of, 11

puborectalis muscle, 14–17

length-tension function of, 20, 21f Anorectal angle, 154–156, 158 Anorectal diseases, and pruritus ani, 118–121

anal fissure, 119–120, 120t hemorrhoids, 118–119 infections, 120–121 psychological causes, 121

Anorectal disorders (ADs), diagnostic tools in,

38f anal MEPs, 42 anorectal sensory and motor function tests,

42–44

balloon distension and rectal barostat,

42–44, 43f anorectal structure tests, 42

endoanal and pelvic floor ultrasound, 42

evacuation tests, 44–45

balloon expulsion test, 44 colonic transit testing, 44–45

defecography, 45 initial approach, 38–39 motor function tests, 39–42

anorectal manometry, 39–41

anorectal neurophysiology, 41

functional lumen imaging probe, 41

translumbar MEPs, 42

transsacral MEPs, 42

266 Index

Anorectal fistula (ARF)

adipose-derived stem cells, 94 classification of, 82–83, 84f clinical presentation of, 83–84 in Crohn’s disease patients, treatment for,

95–97 laser ablation for, 95 nonsphincter-preserving operation, 90–91

fistulectomy, 90 fistulotomy, 91f

seton, 90–91, 91f over-the-scope-clip, 94–95 preoperative imaging of, 85–88, 86–87f sphincter-preserving operation, 91–95, 96f

advancement flap, 91–92, 92f

anal fistula plug, 93

fibrin glue injection, 92

ligation of intersphincteric fistula tract, 93

video-assisted ablation of the fistula

tract, 94

treatment for, 89–95

Anorectal foreign body

body packer, 207 body pusher, 207 clinical assessment of, 202–203

history taking, 202

physical examination, 202–203

radiologic evaluation, 203 epidemiology of, 201–202 ingested foreign body, 207 management of, 203–206, 206f

endoscopic removal, 204 –205

minimally invasive transanal removal, 205

operative removal, 205–206

transanal removal, 203–204 type of, 202t

Anorectal function assessment, using

meneuvers, 32–33 Anorectal junction (ARJ), 154, 156–158 Anorectal malformations

classification of, 179, 180t clinical manifestations and diagnostic

approach, 180–182, 181–182f

follow-up, 185–186 rectovestibular fistula, 179, 180f

treatment for, 183–185

medical approach, 183 surgical approach, 183–185, 184–

186f

Anor

ectal

manometry (ARM), 34–35, 218,

256–257 for evacuatory dysfunction, 40–41, 40f for fecal incontinence, 39–40, 165–167, 167f for motor function tests, 39–41

Anorectal neurophysiology, for anorectal

disorders, 41

Anorectal pain assessment, using maneuvers,

33–34

Anorectal region examination

clinical utility of DRE, 34–35 DRE protocol, 29–34, 30f, 31t

Anorectal sensory tests, 42–44

balloon distension and rectal barostat,

42–44, 43f

Anorectal structure tests, 42

endoanal and pelvic floor ultrasound, 42

Anorectal trauma/injury, 208–209

clinical assessment of, 208–209 grading system of, 208t

Anorectum, embryology of

hindgut, 2–3, 4f theories on development of hindgut, 3–6

Antegrade continence enema, for fecal

incontinence, 173

Anterograde enemas, 224 Antibiotic therapy, for anorectal abscess, 89 Anticoagulants, hemorrhoids in patients

taking, 60–61

Antiplatelet drugs, hemorrhoids in patients

taking, 54

Antiprolapse surgery, 232–233 Apoptosis, 5–6 ARF. See Anorectal fistula (ARF) Aristotle, 179 ARJ. See Anorectal junction (ARJ) ARM. See Anorectal manometry (ARM) Artificial intestinal sphincter, for fecal

incontinence, 174

ASC. See Adipose-derived stem cells (ASC) ATLS. See Advanced Trauma Life Support

(ATLS)

Index 267

Autologous adipose tissue transplantation, for

anal fissure, 76

Azathioprine, for perianal abscess and fistula

in Crohn’s disease, 146

Balloon distension, 42–44, 43f Balloon expulsion test (BET ), 44 Barium defecography, 45, 218 Barium enema, 231 Bascom I technique, 106, 108f Bascom II technique, 106, 110 Benign perineal teratoma, 181f BET. See Balloon expulsion test (BET) BFT. See Biofeedback therapy (BFT) Bioabsorbable synthetic fistula plug, 93 Biofeedback therapy (BFT)

for fecal incontinence, 171–172 pelvic floor retraining, 219–222

pelvic floor therapy with, for anal fissure, 72 Biologic sealant, for pilonidal disease, 111 Body packers, 207 Body pushers, 207 Body stuffing, 207 Botulinum toxin (BT), 219–222

for anal fissure, 74–75 BT. See Botulinum toxin (BT) Bucket-handle malformation, 181, 184f

Calcium blockers ointment, for anal fissure,

67–72

Calcium channel blockers (CCB), for anal

fissure, 74–77

Calcium dobesilate, for internal hemorrhoids,

57 Capsaicin, for pruritus ani, 117–118 Cardiff classification, of perianal disease, 139t CCB. See Calcium channel blockers (CCB) CDC. See Centers for Disease Control and

Prevention (CDC) Ceftriaxone/azithromycin, for gonorrhea, 128 Ceftriaxone, for gonorrhea, 128 Centers for Disease Control and Prevention

(CDC), STDs treatment guidelines, 127 Cervical carcinogenesis, 190–191

Chemical sphincterotomy, for anal fissure,

72–74 Chemotherapy, 192 Chronic constipation, 215–216 Chronic proctalgia (CP), 237 Cicatrization, for pilonidal disease, 105–106 Ciprofloxacin, for perianal abscess and fistula

in Crohn’s disease, 146 Cirrhosis patients, hemorrhoids in, 62 Cloaca, 2–3, 5 Coccygodynia, 246–247 Colonic transit testing, 44– 45, 218 Colostomy

for anorectal malformations, 181–183, 184f for fecal incontinence, 174

Computed tomography (CT) scan

for anorectal abscess, 86–88 for anorectal fistula, 86–

for

anorectal

foreign body, 203

for anorectal trauma/injury, 208–209

Constipation, 215

clinical evaluation, 217 functional testing, 217–218 pathophysiology, 216 therapeutic management, 218–224 treatment options for, 222–224

Conventional fistulography, for anorectal

fistula, 85 Corticosteroids, for hemorrhoids, 119 Crohn’s disease (CD)

patients

ARA/ARF treatment in, 95–97 hemorrhoids in, 61

perianal (see Perianal Crohn’s disease, in IBD

patients) Cryosurgical ablation, for pilonidal disease, 110 Cryotherapy, for internal hemorrhoids, 60 Cryptoglandular theory, 81 CT. See Computed tomography (CT) scan Cytomegalovirus (CMV) and infectious

proctitis, 131–132

Deep pelvic floor muscles, 14–17, 15–19f

anatomy and function, relationship

between, 19–20

268 Index

Defecatory disorders, 216

treatment options for, 219–222

Defecography, 45, 230–231

for fecal incontinence, 169 for pelvic floor disorders, 153–155

magnetic resonance, 155–156 normal findings, 155 parameters, 154

technique, 154 Delorme operation, 255 Descending perineum syndrome, ultrasound

for, 157–158

Diagnosis, SRUS, 228–231

anorectal function tests, 231 histology, 230 radiology, 230–231

Dietary modification, for internal

hemorrhoids, 41 Digestive system, development of, 2f Digital palpation, 32 Digital rectal examination (DRE)

for anorectal dysfunction, 38–39 for anorectal foreign body, 202–203 clinical utility of, 34–35 components of, 31t protocol, 29–34, 30f

digital palpation, 32 inspection, 32 perineal sensation and anocutaneous

reflex assessments, 32

using maneuvers, 32–34 Diltiazem, for anal fissure, 74 Diosmin, for internal hemorrhoids, 57 Distal colostogram, for anorectal

malformations, 182–183, 182f, 185f

Doppler-guided hemorrhoidal arterial

ligation, for grade II–III hemorrhoids, 59–60

Doxycycline, for gonorrhea, 128

for pelvic floor disorders, 153–155 DRE scoring system (DRESS), 34 DRE. See Digital rectal examination (DRE) DRESS. See DRE scoring system (DRESS) Dynamic graciloplasty, for fecal incontinence,

174

Dyssynergic defecation, 215–217

EAS. See External anal sphincter (EAS) EAUS. See Endoanal ultrasound (EAUS) ED. See Evacuatory dysfunction (ED) Electromyography (EMG), for anorectal

disorders, 41

Embryology, of anorectum. See Anorectum,

embryology of Embryonic cell differentiation, 5 EMG. See Electromyography (EMG) Endoanal ultrasonography, 230 Endoanal ultrasound (EAUS), 42

for

anal

fissure, 70–71f for anorectal abscess, 85–86 for anorectal fistula, 85–86, 86–87f, 88 for fecal incontinence, 168, 169f for perianal fistula in Crohn’s disease,

145–146 EndoFLIP, for anorectal disorders, 41 Endoscopic removal, for mendoscopic

removal, 204–205 Endothelin-1, for internal hemorrhoids, 56 Enemas, 223–224 Enterobius vermicularis (pinworms), and

pruritus ani, 120–121 Enterocele, ultrasound for, 157 Evacuation tests, 44–45

balloon expulsion test, 44 colonic transit testing, 44–45 defecography, 45

Evacuatory dysfunction (ED)

anorectal manometry for, 40–41, 40f balloon distension for, 42–43 balloon expulsion test for, 44 colonic transit testing for, 44–45 defecography for, 45 pelvic floor ultrasound for, 42

External anal sphincter (EAS), 9–13, 13f, 41, 156

anal fissure in, 66f endoanal ultrasound for, 42 and fecal incontinence, 162 length-tension function of, 20, 21f muscle fibers of, 12f, 13

External hemorrhoids, 53f

complications of, 55 management of, 55

Index 269

External rectal prolapse surgery, 255, 255f Extramammary Paget disease, 193–194 Extrasphincteric fistula, 83

FB. See Foreign body (FB) Fecal incontinence (FI), 29, 34

anorectal manometry for, 39–40 balloon distension for, 42–44 classification of, 161 defined, 9–10, 161 diagnosis of, 164–169

clinical evaluation, 164–165 diagnostic tests, 165–167, 166t, 167f

rectal sensory testing, 168–169, 169f endoanal ultrasound for, 42 etiology of, 9–10 and external anal sphincter, 13 in IBD patients with perianal Crohn’s

disease, 147

pathophysiology of, 162–164, 163t

alterations in stool characteristics, 164

anal sphincter, 162

neurologic alterations, 162–163

pelvic floor muscle injury, 162

sensory alterations, 164 treatment for, 169–175, 170f

minimally invasive treatments, 172–174

noninvasive treatments, 169–172

Fiber-enriched diet, for anal fissure, 72–75 Fiber supplements, for fecal incontinence, 171 Fibrin glue injection

for anorectal abscess, 92 for anorectal fistula, 92

FiLaC. See Fistula-tract laser closure (FiLaC) FI. See Fecal incontinence (FI) Fissure

anal (see Anal fissure) perianal, in Crohn’s disease

clinical features, 141

treatment, 141–142

Fissurectomy, for anal fissure, 76 Fistula

anal, after surgery for anorectal diseases,

253, 254f

anorectal (see Anorectal fistula (ARF))

extrasphincteric, 83 fourchette, 181f intersphincteric, 82–83 perianal, in Crohn’s disease, 142–147

classification of, 143–144, 143–

144t

diagnosis

of,

145 imaging of, 145–146 treatment for, 146–147, 148f

rectovestibular, 179, 180f subcutaneous, 83 suprasphincteric, 83

transphincteric, 82 Fistula-tract laser closure (FiLaC), 95 Fistulectomy

for anorectal abscess, 90

for anorectal fistula, 90 Fistulotomy

anal incontinence and soiling after, 259

for anorectal abscess, 89–90

for anorectal fistula, 90 Flavonoids, for internal hemorrhoids, 57 FLIP. See Functional lumen imaging probe

(FLIP)

Fluorescent Treponemal Antibody Absorption

(FTA-ABS) test, for syphilis, 129 Foley catheter, 42–43 Foregut, 1 Foreign body (FB), anorectal. See Anorectal

foreign body Foscarnet, for CMV proctitis, 132 Fourchette fistula, 181f FTA-ABS. See Fluorescent Treponemal

Antibody Absorption (FTA-ABS) Functional anorectal pain, 238–243

clinical presentation, 240 definition, 238 diagnostic tests, 240–241 epidemiology, 238–239 management, 241–243 pathophysiology, 239–240 predisposing conditions, 239–240

Functional disorders after surgery for anorectal

diseases, 251–256

anal fissure, 253 anal fistulas, 253, 254f external rectal prolapse surgery, 255, 255f

270 Index

hemorrhoids, 251–252, 252–253f imperforate anus surgery, 255, 256f obstructed defecation syndrome, 253–255,

254f

rectal cancer surgery, 256

Functional lumen imaging probe (FLIP), 9–10,

24–25

for anorectal disorders, 41

Ganciclovir, for CMV proctitis, 132 Gastrointestinal stromal tumors (GISTs),

195–196

Glyceryl trinitrate (GTN), for anal fissure,

67–75 Gonorrhea, and infectious proctitis, 127–128 Goodsall’s rule, 85 GTN. See Glyceryl trinitrate (GTN)

HD-ARM. See High-resolution anorectal

manometry (HD-ARM) Hemorrhoidal disease

classification of, 53, 53f clinical evaluation of, 54–55 external hemorrhoids, complications of, 55 external hemorrhoids, management of, 55 internal hemorrhoids, management of,

55–60

dietary and lifestyle modification, 41 office-based procedures, 60 oral medication, 57 rubber band ligation, 58–60, 59f sclerotherapy, 57–58, 58f topical medication, 56

management in specific considerations,

60–62

cirrhosis and portal hypertension, 62 Crohn’s disease patients, 61 immunocompromised patients, 61 patients taking anticoagulants or

antiplatelet drugs, 60–61

pregnancy, 61 pathophysiology of, 52 prevalence of, 51–52 risk factors of, 51–52

Hemorrhoidectomy, 119

anal incontinence and soiling after, 259 obstructed defecation for anal structure

after, 260

Hemorrhoids

in perianal Crohn’s disease patients, 140 and pruritus ani, 118–119 after surgery for anorectal diseases, 251 –252,

252–253f

Herpes simplex virus (HSV ) and infectious

proctitis, 125–127, 127f Hesperidin, for internal hemorrhoids, 57 High-resolution anorectal manometry

(HD-ARM), for evacuatory dysfunction,

40–41 Hig

h-resolution

anorectal manometry

(HR-ARM), 24–25, 24f Hindgut, 1

embryology of, 2–3, 4f theories on development of, 3–6

HIV. See Human immunodeficiency virus

(HIV) HMO system, 156 HR-ARM. See High-resolution anorectal

manometry (HR-ARM) HSIL, 191 HSV. See Herpes simplex virus (HSV ) Human immunodeficiency virus (HIV ) and

anal fissure, 77 Humans, anal-closure mechanism in

anatomy and function assessment of,

21–23, 23f

IAS. See Internal anal sphincter (IAS) IBD. See Inflammatory bowel disease (IBD) Idiopathic pruritus ani, 116 Ileostomy, for fecal incontinence, 174 Immunocompromised patients, hemorrhoids

in, 61 Imperforate anus surgery, 255, 256f Infections, and pruritus ani, 120–121 Infectious proctitis

amebiasis, 132–133 causes of, 126t cytomegalovirus and, 131–132

Index 271

Infectious proctitis (Continued)

defined, 125 gonorrhea and, 127–128 herpes simplex virus and, 125–127, 127f lymphogranuloma venereum and, 130–131 non-LGV chlamydia and, 130 syphilis and, 128–130, 129f

Inflammatory bowel disease (IBD)

and anal fissure, 77 anorectal abscess and, 81 anorectal fistula and, 81, 89 patients, perianal Crohn’s disease in

(see Perianal Crohn’s disease, in IBD patients)

Infliximab, for perianal abscess and fistula in

Crohn’s disease, 146

Infrared coagulation, for internal

hemorrhoids, 60 Ingested foreign body, 207 Internal anal sphincter (IAS), 10–11, 10f, 156

anal fissure in, 65, 66f, 67, 74 endoanal ultrasound for, 42 and facal incontinence, 162 neural control of, 11

Internal hemorrhoids, 53, 53f

grades of, 54f management of, 55–60

dietary and lifestyle modification, 56 oral medication, 57 rubber band ligation, 58–60, 59f sclerotherapy, 57–58, 58f topical medication, 56

International Anorectal Physiology Working

Group (IAPWG), 218 Intersphincteric fistula, 82–83 Intersphincteric injections, for fecal

incontinence, 173–174 Intussusception

obstructed defecation after stapled

hemorrhoidopexy or STARR operation

for, 260

rectal mucosal, assessment using

maneuvers, 33–34

rectal, ultrasound for, 156

ISDN. See Isosorbide dinitrate (ISDN)

Isosorbide dinitrate (ISDN), for anal

fissure, 74

Itchy anus. See Pruritus ani

Karydakis technique, 106, 107f

LARS. See Low anterior resection syndrome

(LARS) LAS. See Levator ani syndrome (LAS) Laser ablation

for anorectal abscess, 95

for anorectal fistula, 95 Laser depilation, for pilonidal disease, 110 Laser therapy, for internal hemorrhoids, 60 Lateral internal sphincterotomy (LIS)

for anal fissure, 67–72, 74–76

anal incontinence and soiling after, 259 Laxatives, for anal fissure, 72–75 Length-tension

function,

of EAS and PRM, 20,

21f

Levator ani syndrome (LAS), 14–17, 15–19f, 238

anatomy and function, relationship

between, 19–20 LGV. See Lymphogranuloma venereum (LGV) Lidamidine, for fecal incontinence, 171 Lifestyle modification, for internal

hemorrhoids, 56 LIFT. See Ligation of intersphincteric fistula

tract (LIFT) Ligation of intersphincteric fistula tract (LIFT)

for anorectal abscess, 93

for anorectal fistula, 93 Limberg flap technique, 109 Liquid paraffin (mineral oil), 223 LIS. See lateral internal sphincterotomy (LIS) Loperamide, for fecal incontinence, 171 Low anterior resection syndrome (LARS), 256,

260 Lues, and anal fissure, 77 Lumbosacral spine X-ray, for anorectal

malformations, 182 Lymphogranuloma venereum (LGV ) and

infectious proctitis, 130–131 Lymphoid tissue, 195

272 Index

Magnetic anal sphincter (Fenix), for fecal

incontinence, 175

Magnetic resonance diffusion tensor imaging

(MRDTI), of external anal sphincter, 12–13, 14f

Magnetic resonance imaging (MRI)

for anal sphincter, 42 for anorectal abscess, 86–88 for anorectal fistula, 86–88 for fecal incontinence, 169 for perianal fistula in Crohn’s disease,

145–146 Malone procedure, for fecal incontinence, 173 Maneuvers

anorectal function assessment using, 32–33 anorectal pain assessment using, 33–34 rectal mucosal intussusception assessment

using, 33–34

rectocele assessment using, 33–34

Marsupialization, for pilonidal disease,

105–106, 106f MDSCs. See muscle-derived stem cells

(MDSCs) Mebendazole, for pinworm pruritus, 121 6-Mercaptopurine, for perianal abscess and

fistula in Crohn’s disease, 146 Mesenchymal stem cells (MSCs), 94

local injection of, for perianal abscess and

fistula in Crohn’s disease, 147 Mesoderm, 1–3 Metronidazole

for amebiasis, 133 for perianal abscess and fistula in Crohn’s

disease, 146 Micro CT imaging, of external anal sphincter,

12–13 Midgut, 1 Minimally invasive transanal removal,

anorectal foreign body, 205 Mixed hemorrhoids, 53f MLCK. See Myosin light chain through a kinase

(MLCK) Motor-evoked potentials (MEPs)

anal, 42

translumbar, 42 transsacral, 42

Motor function tests, for anorectal disorders,

39–44

translumbar MEPs, 42 MRD. See MRI defecography (MRD) MRDTI. See Magnetic resonance diffusion

tensor imaging (MRDTI)

MRI defecography (MRD), 45

or pelvic floor disorders, 155–156

parameters and normal findings, 155–156

technique, 155 MRI. See Magnetic resonance imaging (MRI) MSCs. See Mesenchymal stem cells (MSCs) Mucosal advancement flap, 91–92, 92f Muscle-derived stem cells (MDSCs), for fecal

incontinence,

175

yGiHealth, 9–10

Myosin light chain through a kinase

(MLCK), 10–11

NAATs. See Nucleic acid amplification tests

(NAATs) Neural control of internal anal sphincter, 11 Neurogenic itch, 115 Neuropathic itch, 115 Nifedipine, for anal fissure, 74 Nitrates, for anal fissure, 72 Nitroglycerine (NTG), 76 Non-LGV chlamydia, for syphilis, 130 NTG. See nitroglycerine (NTG) Nucleic acid amplification tests (NAATs), for

gonorrhea, 128–131

OASIS. See Obstetric anal sphincter injuries

(OASIS) Obstetric anal sphincter injuries (OASIS), 42 Obstructed defecation

for anal structure after hemorroidectomy,

260

after stapled hemorrhoidopexy or STARR

operation for rectocele/

intussusception, 260

Index 273

Obstructed defecation syndrome, after surgery

for anorectal diseases, 253–255, 254f

Operative removal, of anorectal foreign body,

205–206 Opioid-induced constipation, 223 Oral medication, for internal hemorrhoids, 57 Osmotic laxatives, 222–223 Overlapping sphincteroplasty, for fecal

incontinence, 174 Over-the-scope-clip

for anorectal abscess, 94–95 for anorectal fistula, 94–95

Parks classification, of perianal fistula, 143,

143t Paromomycin, for amebiasis, 133 PCDAI. See Perianal Crohn’s Disease Activity

Index (PCDAI) PCL. See Pubococcygeal line (PCL) Pelvic floor disorders, imaging of

defecography, 153–155

normal findings, 155 parameters, 154 technique, 154

MR defecography, 155–156

parameters and normal findings, 155–156 technique, 155

ultrasound, 156

descending perineum syndrome, 157–158 enterocele and sigmoidocele, 157 intussusception and rectal prolapse, 156,

157f

rectocele, 157, 158f spastic pelvic floor syndrome, 158

Pelvic floor muscle injury, and fecal

incontinence, 162 Pelvic floor therapy, for anal fissure, 72–75, 73f Pelvic floor ultrasound, for anorectal disorders,

42 Pen˜a, Alberto, 179 Perianal Crohn’s Disease Activity Index

(PCDAI), 145t Perianal Crohn’s disease, in IBD patients

classification of, 138–149

abscess, 142–147 Cardiff classification, 139t complications after restorative

proctocolectomy, 147–149 fecal incontinence, 147 fissures, 141–142 fistula, 142–147, 143–144t hemorrhoids, 140 skin tags, 139–140 stricture, 142 ulcerations, 140–141

complications of, 138 diagnosis of, 138 epidemiology of, 137–

138

manifestations,

137

erianal eczema/rash, 194 Perianal injury, 209–210 Perianal skin tag, 53 Perineal sensation assessment, 32 Petrolatum ointment, for pruritus ani, 117 Pharynx (phar yngeal gut), 1 Phenylephrine

for fecal incontinence, 171 for internal hemorrhoids, 56

Pilonidal disease

clinical manifestations of, 102 complications of, 103 differential diagnosis of, 102 etiology of, 101–102 incidence of, 101 pathologic anatomy of, 103 postoperative care of, 111 surgical treatment for, 104–111

biologic sealant, 111 conservative management, 110 cryosurgical ablation, 110 cutting seton, 111 excision and primary course, 106–107,

107f

excision and rotation flap, 108–110,

108–109f

excision with open wound, 104–105,

105f incision and curettage, 105, 105f laser depilation, 110

274 Index

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